A qualitative study of Thai HIV-positive young men who have sex with men and transgender women demonstrates the need for eHealth interventions to optimize the HIV care continuum

ABSTRACT

In Thailand, young men who have sex with men (YMSM) and transgender women (TG) are disproportionately affected by HIV and have suboptimal care continuum outcomes. Although Thai YMSM and young TG are early adopters of emerging technologies and have high Internet and technology access and utilization, the potential of technology has not been harnessed to optimize the HIV treatment cascade. We interviewed 18 behaviorally HIV-infected YMSM and young TG regarding care challenges, identified how eHealth could address care needs, and elicited preferences for eHealth interventions. Participants reported struggling with individual and societal-level stigma which negatively impacted linkage to and retention in care, and antiretroviral therapy adherence. YMSM and young TG described inadequate in-person support services and heavily relied on random online resources to fill information and support gaps, but sometimes viewed them as untrustworthy or inconsistent. Participants universally endorsed the development of eHealth resources and proposed how they could ameliorate individual-level fears over stigma and improve public perceptions about HIV. Personalized and integrated eHealth interventions with interactive, user-driven structures, credible content, rewards for engagement, real-time counseling and reminder support could help overcome barriers YMSM and young TG face in traditional HIV healthcare systems and have the potential to improve care outcomes.

KEYWORDS:

• Barriers to care
• eHealth
• young men who have sex with men (YMSM)
• transgender women (TG)
• HIV care continuum
• Thailand

Acknowledgements

The authors thank Dr. Annette H. Sohn for her help in reviewing the manuscript, and all the participants for their contributions, and Adam’s Love study staff for facilitating the interviews. TA, CN, SK and NP designed and conducted the study. TA, CN and KM conducted the data analysis using Dedoose. TA, CN, SK, KM and NP were involved in interpreting the results. TA assumed primary responsibility for writing and revising the manuscript. All authors edited and reviewed the manuscript and gave their final approval for submission to the journal. The content is solely the responsibility of the authors and does not necessarily reflect the views or policies of amfAR or the US Army and the US Department of Defense. The study was approved by the Ethics Research Committee/Institutional Review Board (IRB) at Chulalongkorn University, Faculty of Medicine, Bangkok, Thailand.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This research was supported by ViiV Healthcare and by amfAR, The Foundation for AIDS Research [grant number 109313-58-ISTA].